JC: What is the impact of EMS practitioner experience on OHCA patient outcomes?

Study: Bray J, Nehme Z, Nguyen A, Lockey A, Finn J; Education, Implementation, Teams Task Force of the International Liaison Committee on Resuscitation. A systematic review of the impact of emergency medical service practitioner experience and exposure to out of hospital cardiac arrest on patient outcomes [published online ahead of print, 2020 Aug 5]. Resuscitation. 2020;S0300-9572(20)30302-6. doi:10.1016/j.resuscitation.2020.07.025

What they found?

  • no evidence to suggest practitioners with longer careers have improved patient outcomes (very low certainty of evidence)
  • suggests that EMS with greater recent exposure have improved patient outcomes (very low certainty of evidence)

Impact of year of career experience on OHCA outcomes

  • No studies examined survival with favourable neurologic outcome at discharge/30 days, event survival or ROSC
  • No association with survival to hospital discharge: median ≤5 career years reference group, 5-8 years adjusted odds ratio (AOR)=1.17 (95% CI: 0.99-1.39), 8-11 years AOR=1.11 (95% CI: 0.93-1.34), and >11 years AOR=10.09 (95% CI: 0.91-1.29).

Exposure to attempted resuscitation

  • Annual exposure for individual EMS personal vary: one study
    reported 11% of EMS personnel had no exposure to an attempted resuscitation over the 7 years (!)
  • Higher team exposure in the preceding 3 years was associated with increased survival to hospital discharge: compared to a median of ≤6 exposures, >6-11 exposures=AOR 1.26 (95% CI: 1.04–1.54), 11 to 17 exposures =AOR 1.29 (95% CI: 1.04–1.59), >17 exposures =AOR 1.50 (95% CI: 1.22–1.86).
  • Lower survival to discharge in patients treated by teams with no exposures in the preceding 6-months (AOR 0.70, 95% CI: 0.54–0.91) compared to those with recent exposure (<1 month)
  • Higher exposure of the treating paramedic was associated with
    increased ROSC
    • When compared to the <15 exposure reference group, those with ≥15 exposures had an AOR of 1.22 (95% CI 1.11–1.36)
    • association between ≥10 exposures for the lead paramedic over a one-year period and achievement of ROSC (OR 1.30, 95% CI 1.01–1.69)

In the future…

  • need for EMS to monitor OHCA exposure
  • need for further research exploring the relationship between EMS exposure and patient outcomes
Tommaso Scquizzato
Tommaso Scquizzato

Tommaso Scquizzato is a researcher in the fields of cardiac arrest and resuscitation science at the Center for Intensive Care and Anesthesiology of San Raffaele Hospital in Milan, Italy. He is the Social Media Editor of Resuscitation, member of the Social Media Working Group of ILCOR, and member of the ERC BLS Science and Education Committee.

Articles: 35